ENDOSCOPIC TECHNOLOGIES IN THYROID SURGERY: INTERNATIONAL AND OWN EXPERIENCE

Topicality. With the development of endoscopic technology, minimally invasive interventions on the thyroid gland have been widely developed. The introduction of minimally invasive techniques into practice is associated with the desire to improve the cosmetic effect and reduce surgical trauma for patients. The aim: to study the most popular techniques used in minimally invasive thyroid surgery, to show the advantages and disadvantages of each technique, the likelihood of one or another postoperative complication depending on the method of surgical intervention on the thyroid gland. Material and methods: Among minimally invasive interventions, mini-approaches have become widespread: axillary, anterior thoracic, paraareolar, posterior, transoral. When performing video-assisted surgical interventions, an endoscopic stand, a standard set of instruments (clamps and scissors for endoscopic operations), retractors for creating an operating space are used. Results: Criteria for a differentiated approach to the choice of the method of minimally invasive surgical intervention on the thyroid gland have been substantiated. The main task when choosing a method of surgical intervention is its simplicity, the possibility of rapid development, economic efficiency, and safety. Conclusions: Ensuring the safety and correct technique of performing surgery with mandatory monitoring of the recurrent nerve, visualization of the parathyroid glands made it possible to obtain good clinical results in patients with this pathology.

The role of miniinvasive surgery in the treatment of early thyroid cancer

Minimally invasive thyroid surgery is a relatively new branch that has begun to develop since the 1990s, it comes in response to an increasing incidence in recent decades of thyroid tumors such as cancers and adenomas. Thin minimally invasive thyroid surgery has 2 main directions: with and without approach in the neck region, and those with approach at the neck are divided into endoscopic and non-endoscopic. Miniinvasive interventions have a number of advantages over the classic ones such as reduction of postoperative pain syndrome and analgesic consumption, respectively, shorter residence time and much better cosmetic results. Not all patients with thyroid tumors can be operated minimally invasively, there are a number of selection criteria: early stage of primary thyroid cancer or adenomas smaller than 3.5 cm in diameter, without capsule penetration or metastases, the volume of the gland should not exceed 50 -60 ml are not allowed overweight patients, patients with severe chronic morbidity, patients with a history of surgery on the neck, patients as short as possible, children and the elderly are not allowed too

Surgical approaches for minimally invasive thyroid surgery: review of the literature.

Resumen La tiroidectomía convencional es el procedimiento estándar y más frecuente para el tratamiento quirúrgico de la glándula tiroides. Con el afán de minimizar o eliminar la cicatriz cervical han surgido diferentes abordajes que han evolucionado con el avance de la tecnología. En las últimas décadas nuevos abordajes quirúrgicos se han desarrollado rápidamente, estos abordajes tienen buenos resultados estéticos, endocrinológicos y oncológicos. El objetivo de este artículo es realizar una revisión de la literatura acerca de los diferentes abordajes y accesos remotos para cirugía tiroidea mínimamente invasiva. Realizamos una búsqueda bibliográfica en la base de datos PubMed en junio del 2020 y se recuperaron todas las publicaciones en inglés sobre tiroidectomía mínimamente invasiva desde el año 1996. Se identificaron todos los artículos originales potenciales que se centraron principalmente en la tiroidectomía mínimamente invasiva y se revisaron los textos completos. Conclusión: la cirugía de tiroides ha tenido grandes cambios desde que se describió inicialmente hace casi un siglo. Las nuevas técnicas endoscópicas y robóticas mínimamente invasivas han aportado resultados cosméticos, disminución de dolor post operatorio y una morbimortalidad comparable a la tiroidectomía abierta. A pesar de estos avances, creemos que hay que mantener una actitud crítica, cuestionando y evaluando las indicaciones y contraindicaciones actuales para mejorar, desarrollar y obtener excelentes resultados en el futuro.

PREVENTION OF YATROGENIC DAMAGES OF THE LARYNGEAL NERVES IN TRADITIONAL AND MINIMALLY INVASIVE THYROID SURGERY

Objective. To assess the effectiveness of using the intraoperative neuromonitoring for conventional and minimally invasive surgical interventions on the thyroid gland for the prevention of the laryngeal nerve damage. Material and methods. For achieving this goal it was performed the retrospective analysis of surgical treatment of 310 patients with thyroid gland diseases, and 54 patients were selected, which were divided into 2 groups matched by sex and age, the nature of thyroid pathology and volume of surgical intervention: in the first (main, n = 27) operations were carried out using intraoperative neuromonitoring, in the second (control, n = 27) - visual monitoring of the laryngeal nerves was performed. The survey was performed according to the Russian and international clinical guidelines. Laryngoscopy was performed for all patients before operation and for patients with impaired phonation function - after it. «NIM-Neuro® 3.0» device with special armored endotracheal tubes preloaded with circular (detecting), as well as stimulating electrodes for searching and continuous monitoring of laryngeal nerves was used for intraoperative neuromonitoring during the operation. Results of the study. Traditional interventions were conducted on the 6 patients, minimally invasive nonendoscopic surgical - on 25, video-assisted - on 23. The exterior branch of the superior laryngeal nerve has found in 25 (92.6%) patients of the main group and 8 of the (29.6%) control group. Recurrent laryngeal nerve was identified in 27 (100%) patients of the 1st group and in 26 (96.3%) patients of the 2nd group by visual inspection. In the main group there are no cases of intraoperative fixation of the loss or signal attenuation during the laryngeal nerves monitoring, which is proved by the absence of single- and double-sided paresis of the larynx in the postoperative period. Only in 2 patients there was functional dysphonia on hypotonic type. In the control group the laryngeal dysfunction in the form of functional dysphonia (n = 1), paresis (n = 1) and paralysis (n = 1) has occurred in 3 patients. Conclusion. It has been found out that intraoperative neuromonitoring is an effective additional method of neural structures detecting, and it does not substitute the anatomic visualization of laryngeal nerves. intraoperative neuromonitoring in patients with high risk of complications (repeated operations on the thyroid gland, thyroid cancer with extrathyroidal proliferation and regional metastases) can reduce the incidence of paresis and paralysis of the larynx. All minimally invasive interventions on the thyroid gland should be accompanied by the intraoperative neuromonitoring of laryngeal nerves (8 figs, 1 table, bibliography: 15 refs).

Minimally Invasive Video-Assisted versus Minimally Invasive Nonendoscopic Thyroidectomy

Minimally invasive video-assisted thyroidectomy (MIVAT) and minimally invasive nonendoscopic thyroidectomy (MINET) represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient’s comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques.